Introduction: Prenatal depression is common, affecting 10-15% of pregnant patients. Make sure to screen for this condition as it’s linked with negative birth outcomes like low birth weight and preterm birth. Early detection and intervention are key to protecting both maternal and fetal health.

Growing body of research supports both efficacy and safety in kids. However, the disadvantages—including twice-daily dosing, need to administer with food, and relatively great QT prolongation—give us some pause in our pediatric patients. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Disulfiram is an aversive treatment, causing a buildup of ethanol’s metabolite acetaldehyde in the serum, which in turn causes symptoms such as flushing, dizziness, nausea, and vomiting. Since craving is not reduced by disulfiram and any alcohol ingestion could result in a reaction, nonadherence can be common. Its use should be reserved for selective, highly motivated, and thoroughly informed patients in conjunction with supportive and psychotherapeutic treatment. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

This drug offers some advantages, including no need for titration, once-daily dosing, relatively low-moderate metabolic profile, and relatively low QT prolongation risk. However, its use is limited by the need to administer with ≥350 calories of food, potential for drug interactions, and side effects including sedation, akathisia, and EPS, not to mention relatively minimal data (and certainly no long-term data) in kids. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Better side effect profile and somewhat lower misuse potential than amphetamines. However, patients often prefer the “kick” they get from Adderall. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Not for first-line use for most kids due to limited data (open-label studies only), long titration required, and increased relative risk of rash in pediatric population. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

May be effective and safe for use in performance anxiety, particularly when the sedating or cognitive side effects of benzos could interfere with an individual’s performance, but there are no data in kids.  From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Vitamin D supplementation may be beneficial in adults with depression, but there is only minimal evidence in pediatric patients with mania. Reserve its use for those who have insufficiency, and have your patients take 1000–2000 IU daily. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Although there are only minimal data, consider prazosin for PTSD in kids, especially for PTSD-associated sleep disturbances and nightmares, but monitor BP. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Not commonly used in children, but may be considered in those with severe behavioral disturbances who may benefit from sedation. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).